| NPI | 1447429022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OCTAVIA JACKSON WILLIAMS Credentialing Specialist 318-561-0946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2022-01-19 |